Healthcare Provider Details

I. General information

NPI: 1487945952
Provider Name (Legal Business Name): SANG LEE ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21601 76TH AVE W
EDMONDS WA
98026-7507
US

IV. Provider business mailing address

21601 76TH AVE W
EDMONDS WA
98026-7507
US

V. Phone/Fax

Practice location:
  • Phone: 630-215-9892
  • Fax:
Mailing address:
  • Phone: 630-215-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number60280503
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.006502
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: